October 6, 2025

As we move into fall, our monthly education will focus on rehabilitation. Emergency Scene Rehab is more than rest and water—it’s a structured medical process that protects responders from heat stress, cold exposure, fatigue, and contamination while maintaining operational readiness.  

Once considered a “fireground-only” concern, rehabilitation is now recognized as a universal responsibility across every discipline in emergency response. Whether in suppression, EMS, HAZMAT, technical rescue, or tactical operations, responders face the same physiological stresses that can impair judgment, degrade performance, and increase the risk of injury or death. 

NFPA 1584 provides the foundation for how agencies should manage responder recovery and wellness during and after operations. We emphasize that rehabilitation applies to all incidents and training events that pose a risk of exceeding safe physical or mental endurance. It establishes the framework for relief from climatic conditions, reduction of contamination, hydration, nutrition, and mental decompression. 

Departments are encouraged to collaborate with their EMS medical director to develop Standard Operating Procedures (SOPs) and Standard Operating Guidelines (SOGs) that address these essential functions. These SOPs must outline when and how to establish rehab, the process for rotating crews, and how to manage personnel returning to service. They should also ensure accountability—tracking who enters rehab, what care they receive, and when they are cleared. Documenting rehab protects responders the same way charting protects patients. Agencies should conduct self-audits to ensure that procedures, training, and equipment meet NFPA 1584 standards before the next operational cycle. 

Before the next emergency occurs, ensure your department has integrated rehabilitation into every operation. Normalize its presence at every incident and make responder recovery as essential as scene safety. Rehabilitation is not optional, nor is it an interruption to the mission; it is a critical operational function. 

Until next week,

John B. Hill, MD

Emergency Medicine Physician

UH EMS Medical Director

UH Portage ED Associate Medical Director

NEOMED Clinical Assistant Professor

October 13, 2025

The term “prehabilitation” refers to proactive measures responders can take to ready their bodies and minds before facing the challenges of emergency operations. It involves hydration, nutrition, physical conditioning, and sufficient rest. All of these elements impact how effectively first responders perform under stress.  

NFPA 1582 specifies the medical and physical examinations candidates must pass to ensure they can safely perform essential job tasks. NFPA 1583 emphasizes the importance of maintaining a physical fitness program for emergency responders. Regular exercise, cardiovascular conditioning, and strength training are vital to meet the physical demands of the job. All first responders should maintain their fitness and readiness throughout their careers and are required to meet the standards in NFPA 1582. In fact, NFPA 1582 mandates an annual fitness evaluation, with restrictions on essential job tasks if personnel do not meet the specified aerobic capacity. 

Just as athletes warm up before competition, responders should engage in pre-event stretching and preparation to lower the risk of injury during drills or live operations. Hydration and nutrition also significantly impact performance and recovery. Responders should begin each shift well-hydrated and sustain proper electrolyte levels throughout their activities. Remember, the thirst mechanism is a delayed response; by the time you feel thirsty, you are already dehydrated by about one liter. Dehydration can reduce work capacity by up to 30%. Lastly, don’t forget the importance of sleep. Sleep deprivation and fatigue can impair decision-making as much as alcohol, making rest a vital part of readiness.  

Fire, EMS, and Police Departments can implement prehabilitation by scheduling active warm-ups at the start of the shift, before training, establishing hydration policies, and monitoring crew readiness. Supervisors should recognize signs of fatigue and ensure personnel are recovered before returning to service. Prehabilitation helps ensure that when the call comes, responders already have the physical and mental reserves needed to perform safely and effectively. 

Until next week,

John B. Hill, MD

Emergency Medicine Physician

UH EMS Medical Director

UH Portage ED Associate Medical Director

NEOMED Clinical Assistant Professor

October 20, 2025

Responders work in some of the most extreme environmental conditions imaginable: blazing fires, freezing temperatures, and hazardous atmospheres. Each presents unique physiological and operational risks that require proactive management.

Heat stress remains a major threat to responder health. High temperatures, heavy PPE, and prolonged exertion can quickly raise core body temperatures. The human body mainly cools through sweating, but dehydration and PPE barriers can make this mechanism ineffective. Active cooling methods like air conditioning, forearm immersion, misting fans, and other techniques should be available during all large-scale operations, including training exercises. Passive cooling, such as removing PPE, moving to shaded areas, and using air movers, is equally important.

Heat-related illnesses develop along a spectrum from mild to life-threatening, starting with heat rash and sunburn, then progressing to heat cramps, heat exhaustion, and finally heat stroke. Heat cramps happen when heavy sweating depletes the body’s salt and water, leading to sudden, painful muscle spasms in the arms, legs, or abdomen. Treatment includes moving the responder to a cool environment, loosening clothing, and rehydrating with electrolyte drinks. Heat exhaustion results from significant fluid and electrolyte loss and is marked by heavy sweating, pale, clammy skin, weakness, dizziness, nausea, and high temperature. Managing it involves resting in a cool or air-conditioned space, active cooling methods like forearm immersion or misting fans, and oral or IV fluids. Heat stroke is a medical emergency caused by failure of the body’s thermoregulation. Sweating stops, skin becomes hot and dry, and mental status declines with confusion or unconsciousness. Definitive treatment is immediate ice-water immersion up to the neck and continued until the core temperature drops below 102°F or normal mental function returns. The patient shall then be transported to the hospital for further care. Every department should have a plan for field ice-water immersion, as loading and going only delays treatment.

Cold environments pose the opposite threat. Responders may suffer from trench foot, frostnip, frostbite, or hypothermia when exposed to freezing temperatures or wet conditions without freezing temperatures. Warming methods include removing wet clothing, applying blankets, and using warm packs (not directly on the skin) to gradually rewarm the body. Handle these patients very gently, as they can often experience cardiac arrest with ventricular tachycardia (VT) or ventricular fibrillation (VF) caused by hypothermia. If they go into cardiac arrest, start CPR, deliver a single defibrillation for VT or VF, continue CPR, and transport the patient to a hospital, preferably to an ECMO center if available.

NFPA mandates hazard control zones to segregate contaminated, partially contaminated, and clean areas. Initial exposure reduction must happen in the warm zone before personnel enter rehab, preventing contaminants from being tracked into rest areas and reducing carcinogen exposure. Rehab should be shielded from environmental conditions, be free of exhaust fumes from apparatus, vehicles, or equipment, and not be located downwind of the hot zone.

Responder safety depends on anticipating environmental stressors and implementing structured rehabilitation at every incident. Whether facing searing heat, bitter cold, or toxic contamination, protect the provider to preserve the mission. NFPA 1584 establishes that rehab is not optional but an integral component of operational readiness, ensuring responders recover physiologically and mentally before returning to duty. By planning for cooling, warming, hydration, and contamination control, departments not only comply with standards but also demonstrate a commitment to the health, performance, and longevity of their personnel. The best operations are those where everyone goes home safely: recovered, rehydrated, and ready for the next call.

Until next week,

John B. Hill, MD

Emergency Medicine Physician

UH EMS Medical Director

UH Portage ED Associate Medical Director

NEOMED Clinical Assistant Professor

October 27, 2025

Rehabilitation is not the end of the incident; it’s the bridge to recovery and preparedness for the next call. A well-organized rehab operation ensures responders are safe to return to duty and allows early detection of illness or injury. 

Rehab should start whenever incident conditions or workload pose safety or health risks. For small incidents, this likely means crew-based self-rehab; for larger incidents, a formal rehabilitation team should be established. The Incident Commander (IC) bears the ultimate responsibility but can delegate management tasks to a Rehabilitation Manager, who handles site setup, accountability, and medical assessments. 

University Hospitals recommends at least 20 minutes of rest after a single SCBA bottle or 40 minutes of strenuous activity. Vital signs should be checked every 10 minutes if normal, or every 5 minutes if abnormal. Release criteria include stable vitals, a minimum of 20 minutes of rest, proper hydration, and no signs of medical or psychological distress. 

Post-incident recovery extends beyond the scene. Personnel must perform hygiene decontamination, report exposures, and address behavioral health needs. Supervisors and officers play a vital role in recognizing signs of post-incident stress and connecting personnel to support resources. Rehab is responder medicine, the intersection of operations, health, and leadership. By embedding structured rehab into every incident, we turn responder safety from a reaction into a routine. 

Until next week,

John B. Hill, MD

Emergency Medicine Physician

UH EMS Medical Director

UH Portage ED Associate Medical Director

NEOMED Clinical Assistant Professor